A58 HERPES ZOSTER VIRUS INFECTION IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE: SINGLE CENTER EXPERIENCE

Background Patients with IBD receive a variety of medications that modulate the immune response. However, many medications render patients more susceptible to opportunistic infections. Varicella zoster virus (VZV) infection, in particular, has been well reported in IBD patients, mostly in CD. Chickenpox results from primary VZV infection, and is predominantly seen in the pediatric population. Primary prevention via vaccination for VZV, plays an important role in preventing infections in IBD patients before they start immunomodulators, corticosteroid or biologic therapy. Given the advent of zoster vaccines, it is important to determine if IBD patients should be considered for immunization at a younger age. Aims 1) To document the prevalence of herpes zoster virus (HZV) infection patients with IBD and to further investigate the characteristics of susceptible hosts 2) To assess the severity of herpes zoster in this patient population Methods A single center retrospective cohort study was conducted at the Montreal Children’s Hospital. Pediatric IBD patients (age < 18 years) who developed HZV from 2004- 2019 were identified. Data regarding HZV infection, location, severity, treatment, complications and list of all immunosuppressive medications at the time of HZV infection were retrieved as well as data regarding demographics, medical history, vaccination status including Varicella vaccine, and disease behavior. Results A total of 9 patients were identified from who had VZV infection or HZV. Eight out of 9 patients, had CD and one patient had UC, and 6 out of 8 CD patients had had extensive disease. The vaccine status was up to date in 6 out of 9 patients, and varicella serology was identified prior to starting steroids or biologic agents. Eight out of nine patients were on biologics. Eight patients had local disease, skin only, and one patient had systemic disease with HZV meningitis. Four out of 9 patients had their biologic medications either stopped or the next doses were delayed, while other medications including steroids, methotrexate, thiopurines were continued. Five patients were treated with intravenous acyclovir then oral valacyclovir. The rest started on oral valacyclovir and then switched to intravenous acyclovir due to systemic disease. The overall prognosis of the illness was good, and it resulted in full resolution, including the meningitis case. Conclusions Our study suggests that being on biologic medication plays a significant role in increasing the chances of reactivation of HZV. Although the severity of the HZV infection in our study is limited to skin involvement, there was one systemic infection. Close attention and mandatory documentation of vaccination status is prudent especially prior to starting immunosuppressive medications. Further studies are needed to determine if these patients should be vaccinated with recombinant zoster vaccine. Funding Agencies None

Case report: narcolepsy type 2 due to the optic nerve infection of Herpes zoster virus

Rationale: Despite the acknowledged importance of environmental risk factors in the etiology of narcolepsy, there is little research on this topic. The optic nerve infection of Herpes zoster virus as a trigger for narcolepsy has not been investigated.Patient concerns: A 63-year-old male carpenter complained of excessive daytime sleepiness (EDS) over the past 3 years.Interventions: Treated with duloxetine hydrochloride enteric dissolution capsule (Cymbalta) 120mg after breakfast and clonazepam tablets 0.5mg before sleep.Outcomes: General examination showed no abnormalities of his heart, lungs, or abdomen. Neurological examination showed no positive sign. The blood routine and biochemical examination were normal. Denied having been vaccinated against the flu or having been infected with the flu virus. He scored 17 on the Pittsburg sleep quality index, 22 on the Epworth sleepiness scale, 40 on the self-rating anxiety scale, and 69 on the self-rating depression scale. The multiple sleep latency test data showed 2 periods of sleep-onset rapid eyes movement period across 4 successive tests; the average sleep latency was 7.9 minutes, and the rapid eyes movement latency was 1.2 minutes. Treated with duloxetine hydrochloride enteric dissolution capsule (Cymbalta) 120mg after breakfast and clonazepam tablets 0.5mg before sleep, the patient’s EDS symptoms disappeared immediately. He scored 6 on the Epworth sleepiness scale. During our follow-up three months later, he remained well with no complications.Diagnosis: We diagnosed the patient with narcolepsy type 2 according to the 3rd Edition of International Classification of Sleep Disorders (ICSD-3).Conclusion: The patient suffered from EDS and was diagnosed with narcolepsy type 2. The narcolepsy type 2 was linked to viral infection of the optic nerve. Optic nerve virus infection may affect the sleep-pondering pathway.